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Bilateral Internal Thoracic Artery Bypass Grafting in a High Risk Population - A Four Year Experience with STS Database Derived Clinical Outcomes

Received: 14 July 2019    Accepted: 5 October 2019    Published: 24 October 2019
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Abstract

The purpose of this retrospective review was to examine the morbidity and mortality associated with the routine use of skeletonized bilateral internal thoracic arteries (BITA) in coronary bypass surgery (CABG). The current rate of BITA use is reported to be 5% in the US. The literature reflects an increased incidence of wound complications, especially in obese, diabetic, and female patients. Our policy has been to use skeletonized BITA in patients regardless of comorbidities. Using the Society of Thoracic Surgery (STS) database, the postoperative markers of prolonged ventilation (PV), length of stay (LOS), wound infection, death, and 30 day readmission were evaluated for all isolated coronary bypass operations (isocab) to allow comparison of bilateral and single internal thoracic artery (ITA) use during this four year period. The incidence of BITA use was 60%. The groups had similar comorbities and postop complications were similar regardless of single or bilateral thoracic artery use. Specifically, there were no wound complications in the BITA group. Adjuncts such as ITA skeletonization, platelet rich plasma, negative pressure wound dressing, and absence of bone wax were utilized in all cases. The added expense is justified to allow the expanded use of BITA.

Published in Journal of Surgery (Volume 7, Issue 6)
DOI 10.11648/j.js.20190706.12
Page(s) 158-162
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Coronary Bypass, Skeletonized Internal Thoracic Arteries, Bilateral Internal Thoracic Arteries, Wound Complications, Platelet Rich Plasma, Negative Pressure Wound Dressing

References
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Cite This Article
  • APA Style

    John Jeffrey Tyner, Kate Jensen, Alexander Conkey Tyner, Ashley Jaravata. (2019). Bilateral Internal Thoracic Artery Bypass Grafting in a High Risk Population - A Four Year Experience with STS Database Derived Clinical Outcomes. Journal of Surgery, 7(6), 158-162. https://doi.org/10.11648/j.js.20190706.12

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    ACS Style

    John Jeffrey Tyner; Kate Jensen; Alexander Conkey Tyner; Ashley Jaravata. Bilateral Internal Thoracic Artery Bypass Grafting in a High Risk Population - A Four Year Experience with STS Database Derived Clinical Outcomes. J. Surg. 2019, 7(6), 158-162. doi: 10.11648/j.js.20190706.12

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    AMA Style

    John Jeffrey Tyner, Kate Jensen, Alexander Conkey Tyner, Ashley Jaravata. Bilateral Internal Thoracic Artery Bypass Grafting in a High Risk Population - A Four Year Experience with STS Database Derived Clinical Outcomes. J Surg. 2019;7(6):158-162. doi: 10.11648/j.js.20190706.12

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  • @article{10.11648/j.js.20190706.12,
      author = {John Jeffrey Tyner and Kate Jensen and Alexander Conkey Tyner and Ashley Jaravata},
      title = {Bilateral Internal Thoracic Artery Bypass Grafting in a High Risk Population - A Four Year Experience with STS Database Derived Clinical Outcomes},
      journal = {Journal of Surgery},
      volume = {7},
      number = {6},
      pages = {158-162},
      doi = {10.11648/j.js.20190706.12},
      url = {https://doi.org/10.11648/j.js.20190706.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20190706.12},
      abstract = {The purpose of this retrospective review was to examine the morbidity and mortality associated with the routine use of skeletonized bilateral internal thoracic arteries (BITA) in coronary bypass surgery (CABG). The current rate of BITA use is reported to be 5% in the US. The literature reflects an increased incidence of wound complications, especially in obese, diabetic, and female patients. Our policy has been to use skeletonized BITA in patients regardless of comorbidities. Using the Society of Thoracic Surgery (STS) database, the postoperative markers of prolonged ventilation (PV), length of stay (LOS), wound infection, death, and 30 day readmission were evaluated for all isolated coronary bypass operations (isocab) to allow comparison of bilateral and single internal thoracic artery (ITA) use during this four year period. The incidence of BITA use was 60%. The groups had similar comorbities and postop complications were similar regardless of single or bilateral thoracic artery use. Specifically, there were no wound complications in the BITA group. Adjuncts such as ITA skeletonization, platelet rich plasma, negative pressure wound dressing, and absence of bone wax were utilized in all cases. The added expense is justified to allow the expanded use of BITA.},
     year = {2019}
    }
    

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    AU  - John Jeffrey Tyner
    AU  - Kate Jensen
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    AB  - The purpose of this retrospective review was to examine the morbidity and mortality associated with the routine use of skeletonized bilateral internal thoracic arteries (BITA) in coronary bypass surgery (CABG). The current rate of BITA use is reported to be 5% in the US. The literature reflects an increased incidence of wound complications, especially in obese, diabetic, and female patients. Our policy has been to use skeletonized BITA in patients regardless of comorbidities. Using the Society of Thoracic Surgery (STS) database, the postoperative markers of prolonged ventilation (PV), length of stay (LOS), wound infection, death, and 30 day readmission were evaluated for all isolated coronary bypass operations (isocab) to allow comparison of bilateral and single internal thoracic artery (ITA) use during this four year period. The incidence of BITA use was 60%. The groups had similar comorbities and postop complications were similar regardless of single or bilateral thoracic artery use. Specifically, there were no wound complications in the BITA group. Adjuncts such as ITA skeletonization, platelet rich plasma, negative pressure wound dressing, and absence of bone wax were utilized in all cases. The added expense is justified to allow the expanded use of BITA.
    VL  - 7
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Author Information
  • Prebys Cardiovascular Institute, San Diego, USA

  • Prebys Cardiovascular Institute, San Diego, USA

  • Applied Physics, Northwestern University, Evanston, USA

  • Clinical Care Lines, Scripps Hospital, San Diego, USA

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